Clinical Coder

Role Overview

Clinical Coder at American Hospital Dubai. The role encodes diagnoses and procedures, abstracts patient information, and ensures accurate billing and insurance alignment.

Role Purpose

To encode clinical diagnoses and procedures using the International Classification of Diseases (ICD) coding system, ensure accurate patient documentation and data abstraction, verify alignment between billed services and insurer approvals, and maintain timely closure and dispatch of insurance, corporate, and self-pay batches.

Key Responsibilities

Coding & Documentation

• Encode all relevant, current, and documented diagnoses and procedures as performed by attending physicians utilizing the appropriate International Classification of Diseases (ICD) coding.
• Ensure documentations are completed and specific for coding to the highest specificity and severity.
• Assign appropriate codes and send a request to the physician wherever required.
• Review Coding Edit Engine of Dubai (CEED) filtered Medical necessity and coding edits and ensure additional ICD codes are applied as required or suggested by the Insurance Coordinator.

Data Abstraction & Records Management

• Create an abstract of all demographics, statistical, and medical information from each patient record and enter the data into the coding and abstracting system.
• Review electronic statements for all prescribed diagnostics and pharmacy items along with procedures and complications as documented in the Electronic Medical Record (EMR) and claim form and operative reports.

Insurance & Approval Management

• Understand Health Insurance Policy Terms, Coverage, Exclusion, and Approval requirements as per contractual and regulatory obligations.
• Review approval tracks entered for all approval-required services such as Antenatal Consultations, Diagnostics (CT, MRI), and Surgical Procedures as per the Quick Chart and DPP.
• Ensure billed services align with Approvals provided by the Insurer and Corporate.
• Review services repeated within the same day and seek clarifications and medical necessity from Physicians, Laboratory, Medical Imaging, etc.

Billing & Cost Management

• Apply appropriate guidelines for the assignment of principal and secondary procedures utilizing the CPT-4 procedure code when reviewing claims with the Outpatient Coordinator for billing purposes.
• Prepare cost estimates received from different clinic teams for self-pay patients.

Physician Coordination & Reporting

• Ensure physician queries are sent and reported.

Batch Processing & Dispatch

• Maintain daily productivity targets.
• Ensure delegated Insurance, Corporate, and Self-Pay batches are closed and dispatched in line with the dispatch schedule.

Qualifications & Experience

• Bachelor's Degree in any field (Medical preferred).
• Certified Coding Specialist (CCS) accredited by the American Health Information Association (AHIMA), OR Certified Professional Coder (CPC) accredited by the American Academy of Professional Coders (AAPC).
• Minimum one to two years of experience in ICD-9-CM or ICD-10 coding in an organization handling claims.
• Knowledge of Health Insurance Policy Terms, Coverage, and Exclusions in the UAE preferred.

Skills & Competencies

• Proficiency in Microsoft Office (Excel, Word, PowerPoint, Outlook).
• Ability to speak and write in English.
• Ability to communicate in Arabic preferred.